The effects of
cilazapril 2.5 to 5.0 mg every 24 hours orally for one month on blood pressure, renal hemodynamics, and plasma and urinary
hormones were investigated in 11 patients with renal disease and
hypertension. Six patients had
renal failure (pretreatment
creatinine clearance of less than 1 ml/second). Both systolic and diastolic blood pressures were significantly decreased in all patients and seven of the 11 required 5.0 mg daily. There was no significant change in the effective renal plasma flow, glomerular filtration rate, or
creatinine clearance, although the renal vascular resistance was significantly reduced.
Albuminuria was reduced in most patients but the mean change was not significant. The mean plasma
potassium concentration rose significantly, but no changes in
electrolyte excretion or weight were noted. Mean ambulant plasma
renin activity was normal before treatment and rose significantly. Mean ambulant
angiotensin II concentrations did not change. Mean ambulant plasma
aldosterone concentration and mean urinary
aldosterone excretion decreased significantly. Plasma
arginine vasopressin and
cortisol concentrations did not change. No changes were noted in plasma
glucose concentrations, liver function tests,
hemoglobin concentrations, or white blood cell or platelet counts. A slight looseness of bowel motions occurred in two patients and was the only side effect recorded.
Cilazapril appears to be an effective and safe
antihypertensive drug in patients with
hypertension and renal disease.